OIG to Review PMD Repairs and PAP Supplies
Billing, Reimbursement, Audits and Compliance
on December 04, 2019
The Office of Inspector General (OIG) has updated its work plan to include new reviews for PAP replacement supplies and power mobility device repairs. In a recent article from HME News, Medicare paid approximately $945.8 million for replacement supplies in 2017 and 2018, but OIG has previously found that most claims did not comply with Medicare requirements and that DME suppliers often did not have the documentation required to support the need for replacement supplies.
It was also discovered that Medicare paid approximately $46.7 million for PMD repairs in 2018, including replacement parts. HME News stated that suppliers must maintain documentation from the physician or treating practitioner indicating that the PMD being repaired continued to be medically necessary and that the repairs were reasonable and necessary. DME suppliers must also maintain detailed records describing the need for and nature of all repairs, which includes a justification for the replaced parts and the labor time. In addition, if the expense for repairs exceeds the estimated expense of purchasing or renting another PMD for the remaining period of medical need, no payment can be made for the amount of the excess.
Click here to read the full HME News article.
Do you need assistance in reviewing these claims to ensure they comply with Medicare requirements? The van Halem Group can prepare you for the review process and mitigate potential issues. They’ll walk you through sample audits and suggest changes that can be implemented to avoid long-term issues.
For more information, contact the van Halem Group today!